Provider Demographics
NPI:1801446729
Name:CHIYA, AUDREY R (LMHC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:R
Last Name:CHIYA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-8786
Mailing Address - Country:US
Mailing Address - Phone:808-425-8913
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3503
Practice Address - Country:US
Practice Address - Phone:808-425-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health